The present invention relates to a device and method for removing and replacing an endotracheal tube, and in particular to an endotracheal tube splitter for facilitating the replacement of endotracheal tubes.
The use of endotracheal tubes to facilitate mechanical respiration or ventilation in certain hospital and nursing home patients with various respiratory problems is well known to those skilled in the art. The tube is usually passed through the patient's mouth or nose so that a bottom end of the tube fits snugly in the patient's trachea, while a top end remains extending out of the patient's mouth or nose. In this position, the endotracheal tube enables the patient to be mechanically ventilated or to breath freely, uninterrupted by the respiratory disorder or other limitations.
For a variety of reasons, such as the prevention of infections or the failure of a cuff disposed along the tube, the endotracheal tube must be replaced periodically. Prior to the present invention, this was done by sliding one end of an elongate guide down the endotracheal tube and gently sliding the endotracheal tube out of the patient and over an opposing end of the guide. The replacement endotracheal tube was then slid onto the guide, and then down the guide until it lodged in the proper place in the trachea. A guide for replacing the endotracheal tube in this manner is shown in U.S. Pat. No. 4,960,122.
As will be appreciated by those skilled in the art, this approach has several limitations. First, time is of the essence when replacing the endotracheal tube, as removal and replacement of the tube causes disturbances to the patient's ability to breath. Taking the old endotracheal tube off the guide and threading on the new endotracheal tube adds time to the procedure. Second, such an approach inhibits the use of a bronchoscope during the procedure, instead relying on a simple guide. If a bronchoscope were to be used in accordance with the teachings of the prior art, the limitations of the endotracheal tube would require that the end of the bronchoscope outside of the patient must have an ending which is no bigger than the inner diameter of the endotracheal tube, or an end which is detachable.
In accordance with the present invention, it has been found that splitting the endotracheal tube as it is withdrawn from the patient's mouth provides a superior method for replacing the tube. First, the time to replace the endotracheal tube is reduced by splitting the tube as it is withdrawn so that the replacement tube can be prethreaded over the bronchoscope. Second, the splitting of the tube allows a bronchoscope to be used to view the trachea of the patient as the tube is being withdrawn and as the replacement tube is positioned in the trachea.
The use of a cutting device to remove a tube is not new. For several years the thin tubes used for introducing catheters have been cut as they are withdrawn from the patient. However, there are several important differences between using a cutting device to remove a catheter introducer and an endotracheal tube. First, when cutting an introducer, time is generally not of the essence. The introducer may be withdrawn at any comfortable rate. Second, in most catheter arrangements, the opposing end of the catheter is well placed in the body and slight jerks on the catheter line will not displace the catheter. Third, the introducer tubing is generally soft and flexible.
In contrast, when removing a endotracheal tube, time is of the essence. Typically, the tube must be removed and replaced within about 30 seconds. Additionally, the endotracheal tube must be removed very carefully in that a sudden jerk will often displace the end of the bronchoscope from the trachea into the patient's esophagus. Furthermore, the endotracheal tube is relatively rigid and typically much more difficult to cut than is the tubing of the introducer.
An additional concern with the catheter introducer cutting devices of the prior art is that many have a relatively exposed blade. Because of the introduction location of most catheters, significant protection around the blade is not needed. Even if a slip does occur, the cutter will only cause a small cut to the skin of the patient. In contrast, the use of such a cutter to split an endotracheal tube would be extremely dangerous adjacent the face, as a slip could result in cutting the patient's lip, nose, or worse, putting out the patient's eye.
Thus, there is a substantial need for a endotracheal tube splitter which safely and efficiently splits an endotracheal tube as it is removed from a patient so that a replacement tube may be quickly positioned in the trachea.